2015 > May

The New England Journal of Medicine recently published research linking height and coronary artery disease through the study of genetics. Doctors have known since the 1950s about the link between short stature and coronary artery disease, “but the reason behind this really hasn’t been completely clear,” said Nilesh Samani, a cardiologist at the University of Leicester in the U.K.

Samani and his colleagues looked at the genes of nearly 200,000 people, “and we found a very striking relationship,” Samani said. “We’ve been rather simplistic in our view of what causes coronary artery disease. We thought about traditional risk factors and then genes that might cause coronary disease. But what the study highlights is that developmental processes are going on that probably have an influence on height, and they probably also have an influence on blood vessels of the heart in a way that predisposes you to getting coronary artery disease.”

The challenge now is to ferret out the actual genetic variations that underlie both height and heart disease. “Eventually, of course, there may be some treatments that could emerge from this, but I wouldn’t want to say that’s a short-term possibility,” Samani said.

For someone 2.5 inches shorter than average, the risk of coronary artery disease increases by about 13.5 percent. And the shorter you are, the larger the effect; however, the risk is much smaller than the risk posed by smoking or high cholesterol. Most of the height genes had no obvious connection to heart disease, though a few of them did, such as a trait related to LDL cholesterol and another that influences triglycerides. Those account for less than a third of the effect, leaving the root cause of this link mainly a mystery.

The study also found that people who had more of the height-increasing genetic markers were at lower risk for coronary artery disease. People who had the most height-increasing genetic markers were 26 percent less likely to have coronary artery disease than those with the fewest height-increasing genetic markers.

Shared biologic processes that determine achieved height and the development of atherosclerosis may explain some of the association, notes the study. “We observed significant associations only with levels of low-density lipoprotein cholesterol and triglycerides, accounting for approximately thirty percent of the association,” researches said.

David Goldstein, Director of the Institute for Genomic Medicine at Columbia University is enthusiastic about the opportunities the study brings to the medical community. “As we begin to systematically characterize the genetic bases of these traits, it’s going to open up a whole bunch of brand new windows into biology,” Goldstein says. “And that’s really what I find exciting.”

The study of height and heart disease is also a reminder that traits are usually the result of many different genes acting in concert, so it’s not so simple to alter these traits, for example, to treat or prevent disease.

One major problem with the study is that it looked mostly at white males. With an increase in the diversity of subjects, perhaps scientists could have a better understanding of these genetic traits and markers.

The Internet is usually a place for anonymous negative comments and reviews, but new research has shown that most healthcare consumers consistently give their physicians high marks on the Internet. Vanguard Communications, a 20-year-old Denver marketing and public relations firm specializing in healthcare, developed special software to analyze Yelp.com and Google+ reviews of doctors, group medical practices, clinics and hospitals.

The software searched ratings of over 46,300 providers in the nation’s 100 largest cities and found that 56.8 percent of physicians get four stars or better. At the other end of the satisfaction scale, only one in eight doctors (12.1 percent) gets an average of less than two stars. More than three out of four (77.3 percent) earn three stars or better.

“From our findings, it appears that doctors tend to get much better reviews than hotels, restaurants and retail businesses,” said Vanguard CEO Ron Harman King. “While some doctors indisputably suffer from unjust online comments, our snapshot of American healthcare providers indicates doctors in general enjoy widespread respect and gratitude from patients.”

Patients in San Francisco and Oakland appear to be happiest with their doctors, while the least satisfied American healthcare consumers live in other California cities as well as in New York State locales, the study also revealed.

A similar 2013 study conducted by Vanguard revealed that unhappy patients most often complain about poor customer service and bedside manner four times more often than citing misdiagnoses and inadequate medical skills as cause for their dissatisfaction. The biggest source of complaints was perceived doctor indifference and bedside manner. 43.1 percent of the critics said their annoyance was because the doctor was rushed, late for the scheduled appointment, did not listen well or was otherwise dismissive of their concerns.

As medical consumers increasingly turn to physician rating sites to shop for healthcare providers, anxiety in the medical community is growing over online reviews, with some doctors suing their patients over Internet comments. Nevertheless, a recent study reports that among patients who utilize physician-review websites, 35 percent have selected doctors based on good reviews, while 37 percent avoided doctors based on bad reviews. Prior studies have shown that few physicians are reviewed on rating sites, however, an analysis of one rating site indicated that between 2005 and 2010 there was an increase in the number of physicians rated and the number of ratings per physician.

Now doctors can be satisfied that their patients are treating them well in online reviews.

According to a study published in the American Journal of Public Health in February, a visit to the dentist could be another opportunity to screen patients for diabetes. Doctors found that using gingival crevicular blood for hemoglobin A1c testing produced results nearly identical to those obtained using finger stick blood, the test generally used to diagnose diabetes.

“In light of findings from the study, the dental visit could be a useful opportunity to conduct diabetes screening among at-risk, undiagnosed patients — an important first step in identifying those who need further testing to determine their diabetes status,” Shiela Strauss, PhD, MA, BS, the study’s principal investigator and co-director of the Statistics and Data Management Core for NYU’s Colleges of Dentistry and Nursing, said.

The study, called “The Potential for Glycemic Control Monitoring and Screening for Diabetes at Dental Visits Using Oral Blood,” adds to the previous research that has considered the acceptability to use oral blood to screen for the disease. Dental visits could be potential opportunities for diabetes screening and monitoring glucose control, researchers said. Although many Americans visit their dental providers annually, they might not be seeing primary care providers as frequently. Patients who are at least 45 and older could particularly benefit from this type of screening.

The study included 408 adults with or at risk for diabetes and performed hemoglobin A1c (HbA1c) tests on dried blood samples of gingival crevicular blood and compared these with paired gold-standard HbA1c tests with dried finger-stick blood samples. They also examined differences in sociodemographics and diabetes-related risk and healthcare characteristics for three groups of at-risk patients.

Researchers estimate 8.1 million of the 29.1 million Americans living with diabetes are undiagnosed, with many who have diabetes also having inadequate glycemic control. One out of 3 adults has prediabetes, according to the CDC. Without weight loss and moderate physical activity, the CDC states, 15% to 30% of people with prediabetes will develop type 2 diabetes in five years.

“Our study has considerable public health significance because we identify the value and importance of capitalizing on an opportunity at the dental visit (a) to screen at-risk, but as yet undiagnosed patients for diabetes (especially those 45 years or older), and (b) to monitor glycemic control in those already diagnosed so as to enable them to maintain their health to the greatest extent possible,” Strauss said.

Study recruitment, participation, and data collection took place in the comprehensive care clinics at the New York University College of Dentistry (NYUCD) from June 2013 to April 2014 and funding for this study was provided by the National Institute of Dental and Craniofacial Research.